Secure Form

Way to go!

You’ve taken the first step to correcting your financial situation. There are a number of options when your finances are being stretched to the limit.

We’ll need a bit of information about your current financial situation to do a proper assessment. We promise discretion and privacy of any information you disclose. Once we have this information, we’ll quickly contact you about your options, so you can sleep much better at night.

° indicates a required field.

First Name*
Last Name*
Street Address*
Your Phone Number*
Have you had a loan at Prudent before?*
Your account number(social insurance number) if available.*
How did you hear about us? *
Marital Status*
Number of dependants *
Ages of dependants *


Place of work *:
Length of Employment *
Occupation *
Monthly take-home pay after deductions*


Are you/have you been bankrupt? *
When *
Discharged? *
Monthly Payments*

Consumer Proposal

Have you had/are you in a consumer proposal? *
Monthly Payments
Balance Owing


Do you have a car?*

Car 1

Year/Make/Model *
Kilometers *
Paid off car?*
Car 1 Payment *
Car 1 Balance owing *
In your name? *

Car 2

Year/Make/Model *
Kilometers *
Paid off car?*
Car 2 Payment *
Car 2 Balance owing *
In your name? *

Car 3

Year/Make/Model *
Kilometers? *
Paid off car? *
Car 3 Payment *
Car 3 Balance owing *
Is your name? *

Car 4

Year/Make/Model *
Kilometers? *
Paid off car?*
Car 4 Payment *
Car 4 Balance owing *
Is your name? *

Monthly Expense *

Rent or Own?*
Rent Amount*
1st Mortgage Payment Amount *
1st Mortgage Balance *
House Value *
2nd Mortgage Payment Amount *
2nd Mortgage Balance *
3rd Mortgage Payment Amount *
3rd Mortgage Balance *
4th Mortgage Payment Amount *
4th Mortgage Balance *

Current Debt

Credit Cards (amount owing)*
Pay day loans (amount owing)*
Do you have other loans?*
To who? Please also specify amount owing *
Any debt in collections?*
Please provide an explanation *

By clicking submit, you agree to allow us to contact you by email to discuss your credit solutions. You can opt out at any time.